title: Dynamic MRI confirms support of the mid-urethra by TVT and TVT-O surgery for stress incontinence.
abstract: OBJECTIVE
  To study changes in mid-urethral function with dynamic MRI in stress urinary incontinent women undergoing either tension-free vaginal tape (TVT) or TVT-obturator sling operations.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Forty-two parous women with stress urinary incontinence recruited to dynamic magnetic resonance imaging before and after mid-urethral sling surgery. Control group of 16 healthy women.
  
  
  METHODS
  Dynamic magnetic resonance imaging at rest, during pelvic floor muscle contraction, coughing and voiding with a bladder volume of 200-300 ml. X- and Y- coordinates were used to determine the location of the mid-urethra during these activities.
  
  
  METHODS
  Changes in mid-urethral position after TVT and TVT-obturator operations during the different activities.
  
  
  RESULTS
  Postoperatively the women could elevate their mid-urethra by pelvic floor muscle contraction significantly higher than before the operation (p<0.05). Despite a different support angle between the TVT and the TVT-O mid-urethral slings, we could not see any differences in the movement patterns.
  
  
  CONCLUSIONS
  Mid-urethral slings support the mid-urethra and restrict downward movement during different activities. Movement patterns are similar after TVT and TVT-O operations.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Kuopio, Kuopio, Finland. kirsi.rinne@kuh.fi
authors.forename: Kirsi
authors.initials: K
authors.lastname: Rinne
authors.forename: Sakari
authors.initials: S
authors.lastname: Kainulainen
authors.forename: Sinikka
authors.initials: S
authors.lastname: Aukee
authors.forename: Seppo
authors.initials: S
authors.lastname: Heinonen
authors.forename: Carl G
authors.initials: CG
authors.lastname: Nilsson
mesh_terms: D000328:Adult; D000368:Aged; D003371:Cough; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017773:Pelvic Floor; D011446:Prospective Studies; D012720:Severity of Illness Index; D053825:Suburethral Slings; D016896:Treatment Outcome; D014521:Urethra / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology* / Q000601:surgery*; D014554:Urination; D014563:Urodynamics